Haemodialysis associated amyloidosis (HAA) is a complication of long-term haemodialysis caused by deposition of β2-microglobulin in tissues that most often presents clinically at osteoarticular sites. However, in very rarecircumstances, patients do present initially with oral manifestations of HAA. In a normally functioning kidney, β2-microglobulin is cleared by glomerular filtration and is catabolized in the proximal tubules. This article describes a patient with oral manifestation of haemodialysis associated amyloidosis with an unusual presenting complaint of lingual dysaesthesia.
Glass ionomer cement (GIC) has theunique fluoride release property and able to formionic bond with tooth structure. However, the brittleness of the material results in low hardness. In the present study, a new approach in utilization of local waste materials as fillers for improvement of hardness of GIC is reported.The synthesized wollastonite and mine-silica by-product were individually incorporated into commercial GIC and the Vickers hardness were evaluated. The results shown that the incorporation of 1 % wollastonite into GIC gave ~ 6% increment in hardness compared to the control GIC (66.53H ±7.37 versus 62.66HV±2.98)but not for themine-silica. Thus, wollastonite could be a potential material to be utilized as fillersin dental restorative composite
The aim of this study was to determine the efficiency of different human amniotic membrane (HAM) processing methods on the concentration, purity and integrity of RNA. Two different techniques (Technique1 andTechnique2) were employed for the processing of HAM, which differed in terms of washing solution, sample storage conditions and processing time. Based on preservation of HAM, three groups were formed under each technique. In Technique 1, the groups were fresh frozen 1 (F1), glycerol preserved (GP) and gamma irradiated glycerol preserved (IGP); where else in Technique 2, the groups were fresh frozen 2 (F2), 50%glycerol/Dulbecco’s modified Eagle medium (DMEM) cryopre served HAM diluted with phosphate buffered saline(GB) and 50% glycerol/DMEM cryop reserved HAM diluted with diethyl procarbonate water (GD). Total RNA was extracted from the samples and their concentration, purity and integrity were examined. The F2 sample of which there was no pre-washing step and involved direct sample storage at-80oC, shorter processing time and chilled processing conditions had yielded better quality of RNA compared to the others.
A 69-year-old lady was diagnosed to have mucoepidermoid carcinoma of hard palate 3 years ago. She completed 20 cycles of external beam radiotherapy and 5 cycles of mould brachytherapy and remained asymptomatic until she again presented to us with the recurrence of a painless mass at the hard palate. The hard mass appeared as an ulcerated dimple measuring 2 x 1 cm located at the junction of the hard and soft palate, more towards the right. Excision biopsy of the mass was done with a 1cm circumferential margin deep to the periosteum, with the resulting exposed bony defect covered with a rotational flap from the soft palate. During follow-up, the patient complained that the saliva came up into the nose whenever she swallowed. Oral examination (Figure 1) and flexible nasopharyngolaryngoscopy (FNPLS) (Figure 2) were performed. What is your diagnosis?
Tracheostomy is a life saving surgical procedure performed to maintain upper airway ventilation. The
indications include providing relief of upper airway obstruction, to replace endotracheal intubation in patients needing prolonged assisted ventilation, protection of tracheobronchial tree and facilitates tracheobronchial toilet.More importantly, post operative tracheostomy care is very crucial for the success of the treatment and avoiding complications. We report a rare case of an obligate parasite which had infested the tracheal stoma due to poorhygiene.
Ten percent carbamide peroxide is an effective, safe home bleaching agent. Higher concentrations
are more effective, but there are mixed reports on their hardness and surface roughness effects on resin composites. To evaluate the effect of home bleaching agents; Opalescence Now 10% carbamide peroxide (Ultradent Products, USA) and Perfect Bleach 17% carbamide peroxide (Voco,
Germany) on the surface hardness of microhybrid resin composites; Filtek Z250 (3M ESPE, USA) and Point 4 (Kerr, USA) and their surface roughness of selected treatment. Thirty specimens were prepared using acrylic moulds (4mm diameter x2mm thick). N=5 controls placed in distilled water for 14 days.N=5 treated with Opalescence, and n=5 treated with Perfect Bleach for 2 hours every day for 14 days. Surface hardness was tested using Vickers hardness tester FV-7 (Future Tech Corp, Japan). Data analyzed with Mann-Whitney test with (P
This study was designed to obtain and compare the nasalance scores produced by normal Malay
children and those with repaired palatal cleft. Data from 103 noncleft children and 27 children with repaired clefts were included. All children were of Malay origin with the Malay language (Kelantan dialect) as their first language.Two short and simple test stimuli were constructed in the Malay language;one resembled the Nasal Sentences and the other resembled the Zoo Passage (oral passage) used in nasometer testing. Nasalance scores were obtained with the Nasometer II model 6400 by Kay Elemetrics. Calibration of the nasometer and collection of data followed the recommended protocol outlined in the manual. Nasalance scores for the Oral Passage was significantly higher (p< 0.001) for the children with repaired palatal clefts when compared to scores for children without clefts. However, no differences in nasalance scores were detected between both groups for the Nasal Passage. The normative nasalance scores for Malay children with Kelantan dialect was established, which can be used as an objective reference in the management of Malay patients with resonance disorders.
Madu adalah bahan semulajadi yang dihasilkan oleh lebah madu, Apis mellifera, berpunca daripada madu yang diambil dari bunga yang berkembang atau cecair dari pokok dan tumbuhan yang dikenali sebagai madu nektar dan madu serangga masing-masing. Ia adalah larutan tepu gula, yang kaya dengan protein, mineral, vitamin, asid organik dan polifenol. Madu mempunyai pelbagai khasiat, sifat penyembuhan dan profilaktik disebabkan oleh komponen-komponen yang terkandung di dalamnya. Madu mempunyai beberapa khasiat kesihatan seperti penyembuhan luka, antimikrob, antioksidan dan potensi anti-radang. Ulasan ini adalah berkaitan komposisi nutrien, antioksidan dan kesan terapeutik madu dengan penekanan kepada madu di Malaysia.
Eosinophilic gastroenteritis, an inflammatory disease of unknown etiology, commonly involves the stomach and small intestine with eosinophilic infiltration. Here, we report an unusual case of eosinophilic gastroenteritis involving the entire digestive tract as a manifestation of hypereosinophilic syndrome (HES). A 22-year-old woman presented to us with diarrhoea, pleural effusion, ascites and marked peripheral oeosinophilia. Stool specimens were negative for parasites, ova, bacteria, and fungi. Endoscopic studies showed pangastritis and duodenitis. Biopsy specimens of the oesophagus, stomach, duodenum, ileum, and colon demonstrated oeosinophilic infiltration. A diagnosis of hypereosinophilic syndrome with eosinophilic gastroenteritis involving the entire digestive tract was made. Hence, she was treated with prednisolone. Symptoms and peripheral oeosinophilia rapidly resolved with treatment, and radiological investigations revealed resolution of effusion. This case illustrates the wide spectrum of clinical manifestation of the disease, whereby it involves the entire digestive tract and it also emphasizes the diagnostic yields of endoscopic biopsies.
Orbital cellulits is one of the life threatening event that should not be missed out and must be distinguished from preseptal cellulitis. It is an infective process involving ocular adnexal structures posterior to the orbital septum. High index of suspicion is the key to its diagnosis as even experienced physician can miss. Here, we present a case of a 15-year-old female who presented with progressive swelling over right forehead associated with high grade fever, headache and purulent discharge of the swelling. She was diagnosed with sepsis due to right forehead abscess and was treated with intravenous antibiotics followed with admission. However, she suddenly deteriorated in the ward which required intubation and thereby Intensive Care Unit (ICU) admission. Investigations revealed fluid collection at right retrobulbar space suggestive of an abscess where emergency drainage was carried out. Unfortunately, her condition worsened and patient succumbed at day-10 of admission, despite all efforts.
Genitourinary system is the second most common site of tuberculosis (TB) after pulmonary system. Tuberculosis of the prostate is a rare manifestation of genitourinary tuberculosis. It is even more uncommon if occurring in an immune-competent individual. Prostate TB is usually an incidental finding in transurethral resection of prostate (TURP). Here, we report a case of TB of the prostate in a 70-year-old man who had benign prostatic hyperplasia for two years. TB was diagnosed incidentally post-TURP. In this report, we also discuss additional tests which may help in establishing the diagnosis of genitourinary tuberculosis.
MeSH terms: Humans; Male; Prostatic Hyperplasia; Prostatitis; Tuberculosis, Male Genital; Tuberculosis, Urogenital; Urogenital System; Transurethral Resection of Prostate; Incidental Findings
Access to an intravenous (IV) route is very crucial in emergency patients under resuscitation. The difficulty to access and administer fluid and drugs through intravenous will influence the outcome of patient. In case of unavailable of intravenous route, the alternative is intraosseous access. To date, there is no data available on the prevalence and pattern of intraosseous cannulation knowledge among emergency paramedics in the published literature from our country, even though the use of intraosseous cannulation for emergency patients is being practices. Therefore, the purpose of the present study was to determine the level of knowledge regarding intraosseous cannulation among emergency paramedics. The knowledge related to intraosseous cannulation among emergency paramedics was assessed through structured validated test questions. Fifteen paramedics participated in this study. Majorities of participants were male (86.6%). The age group ranged from 22 – 45 old years. The working experiences were from two to thirteen years. There was only 1 out of 15 participants who had scored 75%. The majority (10) scored 40% to 50%. This suggests that necessity in teaching of intraosseous cannulation among emergency paramedics needs to be emphasised.
MeSH terms: Allied Health Personnel; Catheterization; Emergencies; Emergency Medical Technicians; Humans; Infusions, Intravenous; Male; Resuscitation; Prevalence; Infusions, Intraosseous
Decision making in nursing is one of the most important skills nurses must apply and utilize in their nursing practice. The aim of this study was to determine the perception of clinical decision making ability among nursing students. A descriptive cross-sectional study was conducted in a tertiary hospital. A total of 54 nursing students were recruited using a modified version of Clinical Decision Making in Nursing Scale (CDMNS) adapted from Jenkins (1985). The findings showed good CDMNS score with mean and standard deviation of (124.24±12.713). The four sub-scales of CDMNS were: searching for alternative (33.24±4.821), canvassing (28.74±3.514), evaluation and re-evaluation (31.43±3.922), searching for information (30.83±4.765). Nineteen (35%) of the participants chose nursing as their first choice, whereas 35 participants (65%) did not. Thirthy seven (69%) participants were satisfied with their nursing competency, 17 (31%) were unsatisfied. There were significant differences between searching for alternatives, evaluation and re-evaluation, and nursing as their first choice (p=
Study site: Nursing students, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Clostridium difficile infection (CDI) causes mild to severe diarrhoea and pseudomembranous colitis in patients who had prior antibiotic exposure. Despite CDI being prevalent worldwide, its epidemiological data is scanty in Malaysia. This study aimed to determine the prevalence and incidence of CDI at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Stool specimens from 147-suspected CDI patients were obtained from 1 November 2011 until 31 October 2012. The presence of C. difficile toxin A and/or B were detected using a commercial immunochromatographic kit (Wampole™ Tox A/B Quik Chek). Surveillance data was collected from patients’ medical records to establish the demographic and clinical characteristics. The overall prevalence and incidence of CDI in UKMMC was 6.1% and 5.2 cases per 10 000 patient-days, respectively. Among nine CDI patients, 77.8% were males and 55.6% were Chinese. CDI was most common in medical wards (88.9%). The median age was 60 years and the median length of hospital stay was 13 days. Majority (88.9%) of CDI patients received antibiotics eight weeks prior to CDI. Penicillin-beta-lactamase inhibitors were the most common antecedent antibiotics. Five (55.6%) CDI patients received acid suppressant medications. The in-hospital mortality rate was 22.2%. In conclusion, the prevalence and incidence of CDI at UKMMC is relatively low and occurs sporadically.
The present study aimed to determine the factors associated with CKD stage 3b among type 2 diabetics attending primary care follow-up, specifically the role of angiotensin blockade dosage. This was a pilot unmatched case-control study conducted in a teaching primary care centre. Clinical data of 25 cases of diabetic patients with CKD stage 3b (GFR 30-45ml/min/1.73m2) in 2012 were selected for this study, as well as 103 controls who were diabetic patients with GFR more than 45ml/min/1.73m2 in 2012. Systematic random sampling was employed. Data was obtained from patients’ diabetic records, computerised clinical medical information system and medical case notes. Univariate analysis was done using Chi-square, t-test, Fisher’s exact test and Mann-Whitney U-test. Multiple logistic regression was used to determine the associated factors for development of CKD stage 3b. Cases and controls were different in terms of age, duration of diabetes, use and dosage of angiotensin blockade medications, systolic blood pressure and baseline GFR. Multiple logistic regression revealed that systolic blood pressure (Adjusted OR= 1.08, 95% CI= 1.02-1.14, p=0.013) and baseline GFR (Adjusted OR= 0.90, 95% CI= 0.85-0.95, p
MeSH terms: Adult; Ambulatory Care Facilities; Blood Pressure; China/ethnology; Chronic Disease; Diabetes Mellitus, Type 2; Female; Humans; India/ethnology; Malaysia; Malaysia/ethnology; Male; Medical Records; Primary Health Care; Logistic Models; Case-Control Studies; Statistics, Nonparametric; Renal Insufficiency*
Child birth is associated with severely painful experience for the parturient, and often exceeds one’s expectations. Even though, severe pain is non life-threatening condition in healthy parturient women, it may lead to undesired neuropsychological consequences. When no analgesia was used, postnatal depression may be more common, and this labour pain leads to the development of post-traumatic stress disorder. Epidural analgesia is now considered gold standard for effective pain relief during labour. We here report a case of a 37-year-old G1 P0 patient at term gestation who successfully used epidural analgesia for labour pain management.
We report a case of a 37-year-old smoker who presented with painless and sudden onset of loss of upper field vision of the right eye, associated with one month history of dry cough which was unresponsive to antibiotic and subsequent anti- tuberculosis therapy. Visual acuity at presentation was counting finger. There was bullous retinal detachment on examination. Radiological imaging revealed multiple lung opacities, involving the brain and the right orbit. Bronchoscopy and biopsy confirmed the diagnosis of adenocarcinoma of the lung. This case illustrates masquerade syndrome of which a lung carcinoma harbours behind a seemingly innocent retinal detachment. It also highlights the importance of entertaining lung carcinoma as a differential diagnosis in suspected tuberculosis among heavy smokers.
Emergency Department Overcrowding (EDOC) has been a longstanding problem. It is defined as a situation where the demand for emergency services exceeds the ability of an Emergency Department (ED) to provide quality care within appropriate time frames. Hospital beds closure or access block to ward admission is one of the most important cause of Emergency s e.g. disaster. A surge response entails even greater responses including implementing Department overcrowding. This could be compounded further in events of a patient surge eg affirmative measurement in order to mitigate the issue in tackling the situation. The steps in managing EDOC were: 1. Recognizing EDOC, 2. Initiating action, 3. Maintaining patient flow, 4. Setting clinical goals and 5. Deploying a Surge Team for Advance Triage or Fast Tract.
MeSH terms: Disasters; Emergency Medical Services; Emergency Service, Hospital; Goals; Health Facility Closure; Humans; Triage
Natural products are often perceived as safe due to the absence of artificial or chemical materials in its content. However, many are unaware that some of these compounds, albeit natural in existence, can cause harm. Cinnamon and lemon are two commonly used home remedies for acne. Both these naturally existing ingredients are capable of producing dermatitis upon contact with the human skin. The aim of this article is to create awareness among physicians that natural remedies are not free from harm hence, should look out for any possible untoward reactions that these products may cause. Physicians need to explore the possible use of homemade remedies to treat common or minor ailments during history taking as this information may not be given voluntarily. Early identification of the offending agent, adequate management and future avoidance could help prevent further episodes of contact dermatitis and its complications.
MeSH terms: Acne Vulgaris; Biological Products; Cinnamomum zeylanicum; Dermatitis, Contact; Eczema; Humans; Medical History Taking; Medicine, Traditional
Urban cities are synonym with a high incidence of penetrating chest injuries either from accidents or interpersonal violence. The outcome of penetrating chest wound can vary from immediate death to a prolonged morbidity. We here report a case of 39-year-gentleman who presented to Emergency Department Hospital Raja Permaisuri Bainun, Ipoh, Perak after being stabbed to the chest. His anterior penetrating chest wound was located at the 5th intercostal space medial to the midclavicular line. The stab wound penetrated the myocardium, causing minimal myocardial rupture. He also suffered from left haemothorax and hemopericardium. The haemothorax was drained with insertion of 32 French chest tube. The patient was admitted under the cardiothoracic team and discharged five days later without surgical intervention. He presented again to the Emergency Department with complains of shortness of breath and pleuritic pain. A left ventricular thrombus was detected via echocardiography. Unfortunately, he took his own discharge. Five days later he came again to Emergency Department with sporadic of loss of vision. The mural thrombus dislodged and embolized to the retinal artery causing amaurosis fugax. The patient was treated with aspirin 150mg and his symptoms subsequently resolved.